Clinical Reasoning: An unusual case of subacute encephalopathy

A 52-year-old previously healthy man presented with 8 months of progressive cognitive decline. He complained of months of confusion, fatigue, depression, hypersomnolence, headaches, and, subsequently, urinary incontinence and unsteady gait. His family reported that he spoke of his deceased mother as if she were alive. His executive deficits progressed, leading to termination of his employment and a motor vehicle accident. He was evaluated and treated in Morocco before presenting to our institution for further care.